Diving Accident in Kaatiala, Finland on 26/6/2015

[KenGordon]

This is worth a read.

The Influence of Thermal Exposure on Diver Susceptibility to Decompression Sickness.

Short version, don't be colder doing deco than on the bottom. It makes a bigger difference than you might expect.

 

[JohnnyC]

Here's the RF3.0 talk on thermal protection and its effect on DCS incident percentages.

[video=youtube;5LOD5keSul4]https://www.youtube.com/watch?v=5LOD5keSul4[/video]

 

[Redshift]

Thanks for translating! I had the accident account in Finnish, but hadn't yet tried to use Google's skills to translate it

The lung issues afterward could also be explained by pulmonary DCS, which is essentially a massive shower of venous gas emboli to the pulmonary circulation, which results in decreased blood flow through the lungs and can also cause secondary lung damage.

Best regards,
DDM

I have seen one diver complaining also of being cold after the dive, having trouble breathing and having possible skin rash. Also in cold water diving (around 4ºC). In a case of DCS, what can cause the coldness feeling after the dive?
Can the cold water diving have a greater impact on the lungs and be an important factor for DCS occurring there?

I don't recall ever before reading of a DCS case where there was no omitted deco whatsoever, instead a deadly serious DCS hit resulted (apparently) entirely from exceptional cold.
It makes perfect sense that this could happen, just I'm quite surprised I haven't heard of it happening before.

It is not uncommon at all! Often called undeserved DCS.

This is Kaatiala's map.



And here you can see the entrances when it was still dry. The one referred to by the diver, as the entrance point, is the small whole on the left.



The divers entered the water from the opposite side of the ow are of the quarry. That was quite a swim. They were probably quite warm at the beginning of the dive. In this image you can see where they entered the water and the tunnel entrances are at the far side.



It's a small mine, at a moderate depth, usually with cold water (ice cover in the winter), although it was at 12ºC yesterday. Several deaths have occurred there. Visibility can vary a lot, it was quite bad now, and the existing lines inside are a mess.

 

[Duke Dive Medicine]

I have seen one diver complaining also of being cold after the dive, having trouble breathing and having possible skin rash. Also in cold water diving (around 4ºC). In a case of DCS, what can cause the coldness feeling after the dive?
Can the cold water diving have a greater impact on the lungs and be an important factor for DCS occurring there?

Redshift,

Without more detail on the case you're describing, it would be difficult to say. Johnoly mentioned SIPE (swimming-induced pulmonary edema, AKA immersion pulmonary edema), which is in the differential in a diver (especially a cold one) with breathing difficulty. I don't think that cold water itself would cause any pulmonary changes that would increase the risk of pulmonary DCS, nor would breathing cold air in a diver with otherwise healthy lungs. Being cold, especially on decompression, is one of the known risk factors for DCS. Cold divers hang on to bubbles better, just like cold beers. It's possible that the case you witnessed is another demonstration of this.

Best regards,
DDM

 

[Redshift]

The difficulty breathing is understandable, but I am also intrigued by the divers feeling cold after. In this accident the diver had dried himself and changed and said he couldn't warm up. The one I witnessed hadn't had any problems with the suit and felt also very cold (was even given a thermal blanket) after the dive, at the same time he had the other symptoms.
Is there any mechanism that could explain this when someone has DCS? We know of cold as a factor that increases the chances of DCS, but can feeling cold after the dive be some kind of consequence of DCS as well?

 

[Johnoly]

, ... Johnoly mentioned SIPE (swimming-induced pulmonary edema, AKA immersion pulmonary edema), which is in the differential in a diver (especially a cold one) with breathing difficulty. ...

It's rare that we get this much detail from a dive accident. But it's the analysis and discussions that hundreds of people read in these posts to understand when a chain of events needs to be broken by the diver to avoid an accident. No accident is one single fault (event). It's always a chain of events. Reading accidents like this educates divers in the future to know when to abort the dive immediately. Any diver, can thumb Any dive, for Any reason. We'll see you guys at DEMA in a couple of weeks !!

 

[Duke Dive Medicine]

The difficulty breathing is understandable, but I am also intrigued by the divers feeling cold after. In this accident the diver had dried himself and changed and said he couldn't warm up. The one I witnessed hadn't had any problems with the suit and felt also very cold (was even given a thermal blanket) after the dive, at the same time he had the other symptoms.
Is there any mechanism that could explain this when someone has DCS? We know of cold as a factor that increases the chances of DCS, but can feeling cold after the dive be some kind of consequence of DCS as well?

I've never heard of that but that's not to say it couldn't occur. A spinal hit could cause loss of vasomotor control that could lead to an inability to warm up in some circumstances. The symptoms you're describing could also be attributed to plain old hypothermia.

Best regards,
DDM

 

[Buoy_A]

First let me say how happy I am to hear that the OP has made a significant recovery and I hope they continue to improve. Also, thanks to the OP for posting this thread so that others can be more aware of environmental conditions that can affect various dive outcomes.

Now, I'm about as far from being a doctor as you can get, but this passage got my attention:

There were no rips anywhere, so most likely due to coldness my periferic blood flow had ended or blocked and that is why decompression did not happen. Nitrogen had been in my tissues and after started to bubble up. When my body got warmer and blood flowing the bubbles entered my lungs doing massive damage.
​

It sounds like he's saying that blood flow in his extremities had essentially slowed to such a point as to make nitrogen get "trapped" in this blood, almost the way ice cubes trap air when they freeze. Then, as he "thawed", it introduced the nitrogen into the lungs at the worst possible pressure: 1 ATA (or even less in the helicopter). In other words, when he thought he was decompressing during his stops, he was only partially decompressing. Certain parts of the OP's body decompressed more than other parts. Seems to make dive tables' accuracy suspect in extreme cold environments.

And couldn't this also explain the Pulmonary Edema? If the OP's extremities saw decreased blood flow because the body was pooling the blood as much as possible at the core, isn't this a recipe for IPE? Is it possible the OP first suffered IPE, then a sort of latent DCS that prevented him from quickly recovering from IPE the way a swimmer might?

 

[Storker]

Seems to make dive tables' accuracy suspect in extreme cold environments.

I don't buy your explanation model, but it's well established that cold conditions may increase decompression stress. That's one of the reasons I try to dive conservatively - and these days use EAN32 almost exclusively.

 

[THX723]

I'm also glad the OP is with us today and doing okay. Thank the lord!

The thermal factors he experienced seems to reflect a podcast (POD Diver Radio) I recently listened to on diving thermal physiology by Dr. Neal Pollock:

POD DIVER RADIO: The Scubacast : Thermal Physiology & its effects on Deco Stress,

I noticed someone earlier also linked a video from Rebreather Forum (by Dr. Neal Pollock as well). They're both worth your time to soak in.

It seemed plausible the near-hypothermic (speculatory) condition may have attributed to the reduced off-gassing -ability during the crucial decompression phase. As the core temp begin to rise, after surfacing, so does the ability to off-gassing, which could very well have led to various DCS symptom(s).

This thermal x-factor is not currently being accounted for in the standard decompression algorithm.